Important Points about Medication Review
The use of drugs in patients with reduced renal function can give rise to problems for several reasons:
- failure to excrete a drug or its metabolites may produce toxicity;
- sensitivity to some drugs is increased even if elimination is unimpaired;
- many side-effects are tolerated poorly by patients in renal failure;
- some drugs cease to be effective when renal function is reduced.
- some drugs require dose reduction when renal function is reduced e.g. digoxin, allopurinol
ACEi and ARBs - always beware of rising potassium and falling eGFR, especially when taking both together or with Spironolactone or NSAIDS
NSAIDs - avoid if possible, if not then use lowest effective dose. They will directly antagonise diuretics and antihypertensives.
Spironolactone - beware high potassium especially with ACEi or ARBs
Metformin - suggest avoid if eGFR < 50
Antibiotics - avoid Nitrofurantoin, all tetracyclines except doxycycline / minocylcine